HomeMy WebLinkAbout1996-007757 - remodel bath � PERMIT
. CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 F;t;1 i_�;1;;•J�;
Crystal Bay, Minnesota 55323 Permit Number: - - -
4!tf,`,':�J,
(612) 473-7357 Date Issued: -, ;� � .;,�h,
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SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
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FEE SUMMARY:
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CONTRACTOR: OWNER: — �;�:;�1 a.������t. --
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APPLICANT/PERMITEE SIGNATU E ISSUED BY:SIGNATURE ����,
Total Fee: S %�%• �� DateRecei��ed:
DateApproved:
Entered By: ,�����, Pe:mit�r: '7'7�'7
CITY OF ORONO - BUII..DING PERNIIT APPLICA'I'ION
�I.L I�i 1FORtiI�TION vitiST BE SLBIIITTED Lti FULL BEFORE PL��I REVIEW tiVII..L
BE sT�x�D ------MAR------$--�996
- -----------------
--- - ----------------------------------------- -
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THE :�PPLIC�:vT IS: (circle one) ,,_O�V��R CONTR�CTOR
_.__--- .
JOB SITE �DDRESS: l` I(�'� �'ft-�;`� � ._Y,' -�' �� ZIP: ��`a =~S�l l
N�v1E OF O`Z�"ER: ��A l�,' : ��I ti'�� ���l t���'-�i�',�`� PHO��: (home) -tf"�/ -7 S�3 Z_,
c -z. �~" �DAk%)
. (work) ,��.�:> -- �•"=� ��
v1A�[.u`VG��,LDiz��S: �'.7� 'A`��'c:� t��� h�i�� _CITY;�;_:c��a::�"�� ZIP: `�'-, r� [
CONTRACTOR: ;'�,� � i��'i���K PHONE: jH��t �= t�'� /�l"r.������r.
`�IOBILE PHOVE/PAGER:
�1AIL�i G ADDRESS: CITY: _ZIP:
ST�TE LICENSE: #
ARCHITECTIENGliYEER: ��? '�� .:" PHO�tE:
:VIAILTiVU ADDRESS: CITY: ,Z�:
��`�: REGISTR�TIO�t �
TYPE OF WORK: New Addition Accessory Stnicture
Move �emode Alteration Lanci Alterarion
PROPOSED`VORK(describeindetail): ��,�tC�� t:.(� _%(�, �-'k �,<,;�,�sZf�Tt t' ,2k�c s� �t r :;��.1.�
. r 1 �
( �C�t' ,- C��= i d � - „� _ _�� � f_ ,�= , '.�,�
f �,:. ``
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STORIES: SQ. FEET OF E�CH FLOOR:
NO. OF BEDROOI�IS: GARAGE ST�iLLS: ATT. DET.
� ESTL�1a"1'ED CONSTRUCTIOti VAI.U�TION(escludingland): � %`_���� (,E '
I hereby apply for a building permit and I acknowled�e that the information above is complete
and accurate; that the work will be in conformance with the ordinances and codes of the City
and with the State Buildin� Code; tha� I understand this is not a permit and �vork is not to start
without a permit; and that the work will be in accordance with the approved plan.
, 1
APPLIC��1T'S SIGNATURE: �`� �` ` ; .� . ,•� __� DATE: �'�-/�-�'1Lr"
,
NOTE! Parade of Homes events require separate pe�rtit approval by Police Department and
City Council 60 days prior to the event. ��on permitted events will not be allowed.
_ �
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- C�T�" o� OROI�T
�a ,:, ;f;:�`.- ,� `���o�
�� l,� .P '�_ � Post O�ce Box 66
. .� ,�- 'l:� � -- .� /'.~ CI'VSL'1��2Y��IIIII1f50L2�7����G
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DAT� PRIVaCY ADVLSORY
In accordance �;-ith �1.5. 1�.04. Subd. ?, "Rivhts of subjects o� daca", we would like to
inTorm you that your req_uest ior a p�:r.1i� or license irom the Ciry oi Orono or any oi its
departments may require �-ou �o iurnisn c:.rcain pri��a�e or conTidential intorm.ation.
You are notified that:
1. The info�nation ��eu f�srnish will be used to determine }�our qualirication for the
permit or license requested.
�. You may refuse to suopl}� data. but retusal may require that the City dery the
pernit or �icense.
3. The L*�rormation may be shared �vith other local, state or fed�ral aQencies to t?�.e
e�cter�t necessary to p.'�cess �:�� Pe:rzit or license.
:�. If ��our requested pe:�mit or Iicense requires Council actiorA to approve, some
intormation mav becom� puoiic.
�. You ha��� ce::ain ri�rts und�: �1.S. 13.0^ (see fo�lo�j�in, paa-) to revie�v private
data on yourself.
6, Your full name is reauired to process this application or pe:mit.
PLEA�E PRLV'T
��� � �� j'�L1� �i 1-- yii �C�-
First �Iiad:e Last
f� ._,
� ,� . � ,_ ,t , ���
L
.�ddress
--, �Y�s � ,���a �3 �,� l �/ '7 / -'1 � _j�-,
( � L ��� Sta�e Zip Pr�one
C lry
I understand my riahts as staced above.
. � 4 - '����'Z.�j�''J/
,s � l i
Sianarure �
� TEI.EPiIO?YE—473-73�• E4X-173-0510
513.04 RIGHTS OF SIIBJECTS OF DATA
Subdivision L �pe of ��- The rights of individusls on whom the data is
stored or to be stored shall be es set forth in this section.
- to be given in���l' An.individual asked to
Subd. 2• Information require�
su 1 private or confidential data concerning gmWit�h�in the collecting state agencY,
PP Y
purpose and intended use of the requested ��� whether he may refuse or is legally
political subdivision, or statewide syste�c� gny �oWn consequence arising from '�is
required to supply the requested data; �d (d) the identity of
supplying or ref using to supply private St$te orl f ederal law to receive the data. This.
other persons or ertities authorized by 1 investigative data,
requirement shall raot apply when an individual is asked to supp y
pursuant to szctior !�.Q2, subdivisian �, to a law enforcement officer.
Th
e commissioner of revenue mav place the e��a i�t°��teonsu nsteadhos
subdivision in the individual income tax or Qropertv tax r
on those orms. . - --- - _
Subd. 3.
Ac� to �� bY ����' UPon request to a responsible
authority, an indivicugl shail be informed Wh b�� hPriyateeor confident al.e Upon his
individuals, and wh�:ther it is classified as p � ublic data on
e ta him and, if he desires, shall
further request, an individual who is the subject of stored private or
ind.ividuals shall be shown the data witho o f an�y ��g. �ter an individual hss been
�e informed of the content end meaning the data need not be disclosed io
shown the private dsta snd informed of its meaning, u�uant to this section is
him for six months thereafter unless e dispute or action p
ending or additior.81 data on the in���u e h�ate or p blic datarupongrequest by
� p r o v i d e c o p i e s o f t h p r e q u i r e t h e
responsible authority shall p
the individual subject oft�e actual.co ts of mak ng,l�eatl Yingy a�d �ompiling the
requesting person to pay - re uest
copies. 1 immediately, if possible, with any 9
The responsible authority shell comp y
made pursuant to �:his subdivision, or with��8 e��f Simmediateatcompliance e��.su not
excluding Saturdays, Sundays and le�al YS
4 � � with the reauest within that time, he shall so inform the
possible. Ii he car:;;�� �Qr•apl� wirhir� which tc �om�ly with the
individual, and ma:� ha�e an addition$1 five days
request, excluding �aturdays, SundaYs �d legal holidays.
Subd. 4. Proce�ure �►hen data � ublic o�r p ivate dat1a iconce nnng h�m e�•mTo
contest the accuracy or completeness of P the res onsible authority
exercise this right, an individuel shall notify in writing P
describing the nature of the disagreement. eTnacctu�a e or in omQlete and at pt to
days either: (a) correct the data found to b
notify past recipients of inaccurate or incomp�t he believesdthe datalto be correct
the individu8l; or (b) notify the individual
Data in dispute shall be disclosed only if the individual's statement of disagreement is
• included with the �isclosed data• ealed ursuant to the
� The determination of the responsible authority may be aPP P
provisions of the administrative procedure act relating to contested cases.
..
" ' CHECb OFF LIST FOR ISSU�o� OF PERI�IITS
FOR OFrICE USE
�DDRESS OFtLEG:�I.: z.?� �sGO PT �O'� PID:
DESCRIP'IZO\ OF «4R�i: ►?.�-`x�4 � ��'n'�
DATE APPROVED: �
ZO\�G REti'I�V BY: N�� DATE ?�PPROV�D: 3 -6-5� .
BL-II.DL\G RE`�tiV BY:
FEES TO BE C�-L�RGED: � �o
l�lisc. F�s Calculated By:
PE�tifIT Yes S��CONiy`ECTION
PL.�v REVIE�V Yes v� �
ST:�TE SURCH.�RGE Yzs � vo �`°'� C������
No PARK FEE
INVESTIG:�TIOv F�E Z'�S v S� �SPECI�ION
SAC _VeS ' ° QTHER (sPeciry)
Numoer of S�.0 tinits _____._._
� Cii LIST LOIIlII� Discrict: S ore?2�d DiSiIICI :
ZONL�G C� ;
Sch�ol Dis��:
Fire Depanmen�: f Post Off:ce: � ;
� Denth
Acres ' Wlatn f
Loc?.rea: Sq.fr. ;
( ��o Dace of�urvey:
Survey Suomicted: � es �
1 � � '
Proposed Setbac!cs: �, � '� �;
F:ont �Lal:e) � Rigut Side: � i
� � i
Re:s (Street�: � _�_ i--en Side: i
1 �
r � ir i
' ��etland: �
Adjacen� S�ruc:ures: '� �`� ,
�eai� Hgt.� �
Building Hei¢hc: �ez. H�t. !
� Bl�ff Secbacic: i Loc Coverage'
Avg. Sezbacic: , ,,.-- �
� j i
' oposed
E isting �
Hardcover: 0-7�' , I
75-�`0 �; --
�50-�00' '�,
�GO-1000' j i
i
Hardcover V 'ance Rev,uired: � . o Daie oi Council Appro ai:
Gcadin�: St �� Approval Date: , Bv: Councl 3ppro al Da�e:
I'� By:
Sepcic: Sta� �•pproval Dace: 1
ZoninQ File: ________—
Resoiucion: � R:solution Dace.
�ti�g�S (in house):
. � 26
BL�II.DL`rG RE`��j' C�C�' LIST
LTBC: �'3 CO�tSTRtiCTION TYPE: Kl'`�
Sa Fooca�e S Pez Sa F��
Basement t =
lst Floor t =
?:_d Floor � _
Gara�e � _
C
TOT:�L
��
S �� S--a• �
Estimated Constn.►ction Value:
Inspeciions Required: �Vork Requirin� Separate Permits:
�, P!umoing Fire
Si[e Wa[e: Connection
Hardcover Removal `�ie�'"'I�al
Seocic Sewer Conneccion
Foocin� Lawn Irri�acion
�� Framin; Fireplace p�er
(l�f aso nry)
Insulacion Well (Stace Permi�)
Wall Board �fiFiilin oQElectric:l (State Pe:mit)
_�Final Gradin�. �
Other �_
�y�ggS (L�t HOL''S�:
REVIEW BY OTIIERS:
DATE:
Access: Ezisti.n� ______
New �_
Access Approval: Da[e
B�.:
���---7'p gE NOTED ONPERti�=
RE1��IARKS (
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